Cancer Subsites Research Articles

Multimodality Diagnosis of Laryngeal Cancer in “Dharmais” National Cancer Hospital (DNCH)

Background: Almost 95% of laryngeal cancers are squamous cell carcinoma. Most of them come from the supraglottic and glottic regions. Globally from 1990 to 2017, there was an increase in the incidence of laryngeal cancer by 58.67%. Patients with suggestive grievances of laryngeal cancer symptoms are usually advised to do a further examination. The use of multimodality diagnosis is helpful for the diagnosis of cancer. Diagnostic procedures in diagnosing laryngeal cancer can be made by history and physical examination, clinical (laryngoscopy), and supporting examination (radiology and biopsy). This study aims to determine the distribution of the demographic (gender, age, domicile, marital status, and educational level), clinical distribution (voice changes, respiratory disorders, pain, dizziness, cough, lump on the neck, and others), and modalities of diagnosis (anamnesis, clinical examination, radiology, and biopsy) in laryngeal cancer.Methods: Descriptive study and a routine data-based study was conducted by collecting data on cancer patients who were diagnosed with laryngeal cancer from 2003 to 2007 by the microscopic either in Dharmais National Cancer Hospital (DNCH) or other hospitals. The study sample was 53 out of a total of 68 cases of laryngeal cancer who had been diagnosed with malignancy histopathologically at DNCH or in other hospitals with epithelial or non-epithelial types with completed medical records. Results: The glottic region is the most common subsite, that is, 52.8%, and squamous cell carcinoma (SCC) is the most common histopathological type of laryngeal cancer. In most of the cases, either males or females presented with a change in the voice of 68.8% and 80% respectively. In 6 out of 12 cases have not been examined microscopically before, while 7.5%.of the cases have done the diagnostic procedure completely in DNCH. Conclusions: The most common subsite and histopathological type of laryngeal cancer is glottis and SCC. The most common clinical feature in both sexes is voice changes. Most cases have not been examined according to the standard diagnosis procedure completely.

Evolution of the Incidence of Oral Cavity Cancers in the Elderly from 1990 to 2018.

To describe the evolution of the incidence of oral cavity cancers (OCC) among elderly patients in France between 1990 and 2018 and to compare it to the incidence of other cancers sharing the same main risk factors. The incidence of cancers in mainland France from 1990 to 2018 was estimated from incidence data observed in every cancer registry of the Francim network. Incidence was modeled by a 2-dimensional penalized spline of age and year of diagnosis, associated with a random effect corresponding to the registry. The elderly population was divided into two groups: 70-79 years old and ≥80 years old. There was a 72% increase in the number of OCC cases in women over 70 years of age between the periods 1990-1999 and 2010-2018. As for men, there was a stabilization in the number of cases (+2%). Over the same period, for laryngeal and hypopharyngeal cancers, there was a decrease in incidence in elderly men and an increase in elderly women, although less marked than for OCC. Since the 1990s, the incidence of OCC has been increasing in elderly subjects in France, particularly in women. Population aging and growth or alcohol and tobacco consumption alone do not seem to explain this increase, which is not observed in the same proportions for other upper aerodigestive tract cancer subsites sharing the same main risk factors.

A Review of the Current Clinical Evidence for Loco-Regional Moderate Hyperthermia in the Adjunct Management of Cancers.

Regional hyperthermia therapy (RHT) is a treatment that applies moderate heat to tumours in an attempt to potentiate the effects of oncological treatments and improve responses. Although it has been used for many years, the mechanisms of action are not fully understood. Heterogenous practices, poor quality assurance, conflicting clinical evidence and lack of familiarity have hindered its use. Despite this, several centres recognise its potential and have adopted it in their standard treatment protocols. In recent times, significant technical improvements have been made and there is an increasing pool of evidence that could revolutionise its use. Our narrative review aims to summarise the recently published prospective trial evidence and present the clinical effects of RHT when added to standard cancer treatments. In total, 31 studies with higher-quality evidence across various subsites are discussed herein. Although not all of these studies are level 1 evidence, benefits of moderate RHT in improving local tumour control, survival outcomes and quality of life scores were observed across the different cancer subsites with minimal increase in toxicities. This paper may serve as a reference when considering this technique for specific indications.

Kruppel-family zinc finger proteins as emerging epigenetic biomarkers in head and neck squamous cell carcinoma

BackgroundKrüppel-type zinc finger protein genes located on chromosome 19q13 are aberrantly hypermethylated with high frequency in all anatomic sub-sites of head and neck cancers as well as other epithelial tumours resulting in decreased expression.MethodsWe examined prognostic significance of ZNF154 and ZNF132 expression and DNA methylation in independent patient cohort of about 500 head and neck cancer patients in the Cancer Genome Atlas (TCGA). We also overexpressed these genes in HEK-293 cells, as well as the oral cancer cell line UM-SCC-1.ResultsIn 20 patients from the TCGA cohort of HNSCC patients where ZNF154 and ZNF132 DNA methylation and RNA expression could be compared in tumor and adjacent normal tissue, there was increased DNA methylation and decreased expression of both ZNF154 and ZNF132 in primary tumours. Low ZNF154 and low ZNF132 expression were associated with shorter overall survival in both head and neck squamous cell carcinoma (HNSCC) and lung adenocarcinoma (LUAC patients). While expression of these proteins in HEK-293 cells produced full-length protein, only truncated copies could be expressed in head and neck cancer cells (UM-SCC-1). The truncated version of ZNF154 protein increased doubling time and reduced cell migration in UM-SCC-1 cancer cells.ConclusionsBoth ZNF132 and ZNF154 represent novel clinically significant biomarkers in head and neck cancer with potential tumour suppressive properties. Future studies will address the underlying molecular mechanisms by which ZNF154 expression in HNSCC contributes to the control of cell growth and migration.Graphical abstract

Consumption of Coffee and Green Tea and the Risk of Colorectal Cancer in Korea: The Health Examinees Study.

Coffee and green tea may affect colorectal physiology and contain many bioactive components, such as polyphenol and caffeine, which have antioxidant and anti-carcinogenic activities. However, the association between coffee and green tea consumption and the risk of colorectal cancer (CRC) has been inconclusive. This study examined the association between coffee and green tea consumption and the risk of CRC in a large-scale prospective cohort study in Korea. Data from the Health Examinees study from 2004 to 2013 were analyzed, and 114,243 participants (39,380 men and 74,863 women) aged 40-79 years were included in the final analysis. A Cox proportional hazards regression model using age at time scale was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of coffee and green tea consumption for the risk of CRC by sex. In both men and women, no significant association was found between coffee and green tea consumption and the risk of CRC. Among women, there was a significant increase in the risk of colon cancer (HR, 1.66; 95% CI, 1.13-2.44) in the black coffee drinker group. Our findings suggest that consumption of coffee and green tea may not be associated with the CRC incidence in Korea; instead, the association may differ depending on cancer subsites and coffee types.

Genetic Predictors for Fecal Propionate and Butyrate-Producing Microbiome Pathway Are Not Associated with Colorectal Cancer Risk: A Mendelian Randomization Analysis.

Mechanistic data indicate the benefit of short-chain fatty acids (SCFA) produced by gut microbial fermentation of fiber on colorectal cancer, but direct epidemiologic evidence is limited. A recent study identified SNPs for two SCFA traits (fecal propionate and butyrate-producing microbiome pathway PWY-5022) in Europeans and showed metabolic benefits. We conducted a two-sample Mendelian randomization analysis of the genetic instruments for the two SCFA traits (three SNPs for fecal propionate and nine for PWY-5022) in relation to colorectal cancer risk in three large European genetic consortia of 58,131 colorectal cancer cases and 67,347 controls. We estimated the risk of overall colorectal cancer and conducted subgroup analyses by sex, age, and anatomic subsites of colorectal cancer. We did not observe strong evidence for an association of the genetic predictors for fecal propionate levels and the abundance of PWY-5022 with the risk of overall colorectal cancer, colorectal cancer by sex, or early-onset colorectal cancer (diagnosed at <50 years), with no evidence of heterogeneity or pleiotropy. When assessed by tumor subsites, we found weak evidence for an association between PWY-5022 and risk of rectal cancer (OR per 1-SD, 0.95; 95% confidence intervals, 0.91-0.99; P = 0.03) but it did not surpass multiple testing of subgroup analysis. Genetic instruments for fecal propionate levels and the abundance of PWY-5022 were not associated with colorectal cancer risk. Fecal propionate and PWY-5022 may not have a substantial influence on colorectal cancer risk. Future research is warranted to comprehensively investigate the effects of SCFA-producing bacteria and SCFAs on colorectal cancer risk.

Association between Tumor Microbiome and Hypoxia across Anatomic Subsites of Head and Neck Cancers.

Purpose/Objective(s): Microbiome has been shown to affect tumorigenesis by promoting inflammation. However, the association between the upper aerodigestive microbiome and head and neck squamous cell carcinoma (HNSCC) is not well established. Hypoxia is a modifiable factor associated with poor radiation response. Our study analyzed the HNSCC tumor samples from The Cancer Genome Atlas (TCGA) to investigate the relationship between different HNSCC tumor subsites, hypoxia, and local tumor microbiome composition. Results: A total of 357 patients were included [Oral cavity (OC) = 226, Oropharynx (OPx) = 53, and Larynx/Hypopharynx (LHPx) = 78], of which 12.8%, 71.7%, and 10.3%, respectively, were HPV positive. The mean (SD) hypoxia scores were 30.18 (11.10), 24.31 (14.13), and 29.53 (12.61) in OC, OPx, and LHPx tumors, respectively, with higher values indicating greater hypoxia. The hypoxia score was significantly higher for OC tumors compared to OPx (p = 0.044) and LHPx (p = 0.002). There was no significant correlation between hypoxia and HPV status. Pseudomonas sp. in OC, Actinomyces sp. and Sulfurimonas sp. in OPx, and Filifactor, Pseudomonas and Actinomyces sp. in LHPx had the strongest association with the hypoxia score. Materials/Methods: Tumor RNAseq samples from TCGA were processed, and the R package “tmesig” was used to calculate gene expression signature, including the Buffa hypoxia (BH) score, a validated hypoxia signature using 52 hypoxia-regulated genes. Microbe relative abundances were modeled with primary tumor location and a high vs. low tertile BH score applying a gamma-distributed generalized linear regression using the “stats” package in R, with adjusted p-value < 0.05 considered significant. Conclusions: In our study, oral cavity tumors were found to be more hypoxic compared to other head and neck subsites, which could potentially contribute to their radiation resistance. For each subsite, distinct microbial populations were over-represented in hypoxic tumors in a subsite-specific manner. Further studies focusing on an association between microbiome, hypoxia, and patient outcomes are warranted.

Risk and survival in colorectal cancer with increasing body mass index: A nationwide population-based cohort study.

The aim was to explore potential associations between the body mass index (BMI) and the risk of colorectal cancer (CRC), including subsites of the colon, and cancer-specific death. A registry-based cohort study was conducted with baseline data gathered from the Norwegian Tuberculosis Screening Programme, collected between 1963 and 1975, and linked to follow-up data from the Cancer Registry of Norway and the Norwegian Cause of Death Registry. Cox regression models were used to explore associations between BMI and CRC risk and cancer-specific death. Of 1723 692 included individuals, 76 616 developed CRC during 55 370 707 person-years of follow-up. In men, a 5kg/m2 increase in BMI was associated with an increased risk of colon cancer, including both right and left subsites, and rectal cancer. Allowing for nonlinearities, we found a U-shaped association for the right colon and an inverse U-shape for the left colon and rectum cancer. In women, a 5kg/m2 increase in BMI in early adulthood was associated with increased risk of colon cancer, including both subsites. In women, an increased risk of CRC death with increasing BMI was found for colon cancer. Men of all ages have an increased risk of CRC with increasing BMI, with the highest risk for right-sided colon cancer. An increased risk for colon cancer was also found in women with high BMI in early adulthood. Furthermore, women of all age groups appeared to have an increased risk of CRC death with higher BMI.

239P Prospective evaluation of difference in patient-reported swallowing outcomes and quality of life of tongue vs bucco-alveolar complex cancers treated with ablative surgery

Oral cancer surgery includes radical resections of the mandible and tongue, affecting the functional swallowing outcomes. However, risk factors and swallowing outcomes are not the same for all subsites of oral cancer. The present study aimed to assess the difference in patient-reported swallowing function and quality of life after primary surgical resection in tongue vs bucco- alveolar complex (BAC) malignancies.

Association of Tumor Microbiome and Hypoxia Expression Signatures in Different Anatomic Subsites of Head and Neck Cancer

<h3>Purpose/Objective(s)</h3> Tumor response to radiation is dependent on the presence of oxygen with hypoxic tumors requiring a two to three-fold higher dose of radiation to achieve clinical equipoise. Head and neck squamous cell cancers (HNSCC) are the most hypoxic among various cancers, as observed in the The Cancer Genome Atlas (TCGA) dataset of 10,700 samples. Potentially related to this, tumor microenvironment (TME) in specific subsites has more anaerobes compared to the normal oral mucosa. The purpose of our study was to analyze the relationship between tumor subsite, hypoxia, and the local tumor microbiome in HNSCC using data from TCGA. <h3>Materials/Methods</h3> Tumor RNAseq samples from TCGA were processed through the exoTIC (exogenous sequencing in tumors and immune cells) pipeline to identify and count exogenous sequences, filter contaminants, and normalize expression values. The software ‘tmesig' was used to calculate gene expression signatures of the TME, including the Buffa hypoxia (BH) score, a validated gene signature that uses 52 hypoxia-regulated genes. Microbe relative abundances were modeled as the response variable with primary tumor location and a high vs low tertile BH score as predictor variables using a gamma-distributed generalized linear regression via the "stats'' package in R. Adjusted p-value of <0.05 was considered significant. <h3>Results</h3> A total of 357 patients were included [Oral cavity (OC) = 226, Oropharynx (OPx) = 53 and Larynx/Hypopharynx (LHPx) = 78] out of which HPV was present in 12.8%, 71.7% and 10.3% patients respectively in OC, OPx and LHPx tumors. The mean (SD) BH scores were 2.38 (18.17), -3.38 (20.45) and -4.97 (16.74) in OC, OPx and LHPx tumors, respectively, with higher values indicating greater hypoxia. The hypoxia signature was significantly higher for OC tumors compared to OPx (p= 0.044) and LHPx (p = 0.002), but was not statistically different between OPx and LHPx tumors (p= 0.625). Patients with upper tertile of BH scores had 395 microbes significantly enriched in tumors vs 307 microbes in patients with lower tertile of BH. The hypoxia expression signature was significantly associated with 413, 206 and 130 microbes in the OC, OPx and LHPx, respectively. Different strains of microbes were significantly associated with hypoxia depending on the tumor location, specifically, <i>Pseudomonas sp</i> in OC, <i>Actinomyces sp</i> and <i>Sulfurimonas sp</i> in OPx, and <i>Filifactor sp</i> in LHPx. In OPx cancer, there were no microbes significantly associated with hypoxia conditional in the presence of HPV. <h3>Conclusion</h3> Oral cavity tumors were associated with the greatest degree of hypoxia among HNSCC subsites, suggesting a potential mechanism for radiation resistance. In this study, we were able to identify an association between specific anaerobic microbes and relative hypoxia in different tumor subsites. Further investigation is required to determine if this is a causal relationship and whether modification of the microbiome in the TME can lead to reduced hypoxia and improved radiosensitivity and outcomes.

Patterns of Neck Nodal Metastasis from Oral Cavity Carcinoma.

Nitin KhuntetaObjectives The aim is to study the patterns of lymph node metastasis from various sites in oral cavity cancer and determine the risk factors for metastasis. Materials and Methods It is a prospective observational study. The inclusion criteria were-245 patients of carcinoma buccal mucosa, anterior two-thirds of tongue, hard palate, oral surface of soft palate, floor of mouth, vestibule, and alveolus. The exclusion criteria were-patients who had received preoperative chemotherapy or radiotherapy and patients with recurrent disease. Statistical Methods All data were analyzed using SPSS 18.0 and Graphpad prism 7 software for statistical analysis. Count data have been expressed as percentages (%). The χ 2 test was used for univariate analysis of the risk factors of cervical lymph node metastasis. The odds ratio value (with 95% confidence interval) was used to express the risk of cervical lymph node metastasis. p -Value of <0.05 was considered as the difference with statistical significance. Results The most common site involved was buccal mucosa. Patterned lymph node metastasis was seen in 93.5% cases. Skip metastasis was seen in 4.31% cases. Level I b was the most common site of nodal involvement for all primary subsites of oral cavity cancer. The incidence of positive nodes on histopathological analysis was highest in cases of lower alveolus (63.15%), followed by tongue. Conclusion In our study, patterns of lymph node metastasis for oral cavity cancer were comparable to other studies with large number of subjects. The incidence of skip metastasis or aberrant status was low. On multivariate analysis, depth of invasion of tumor, pathologic grade, pathologic T stage, and morphologic type of growth were found to be independent predictors of risk for metastasis.

Oral Cancer Disparities in the Outer US-affiliated Pacific Islands.

Oral cancers in the US-affiliated Pacific Islands are poorly described despite disproportionately higher incidences in certain jurisdictions. This study attempts to better characterize the incidence, staging, and management of oral cancers in this region. Retrospective Epidemiological Study. A retrospective review was conducted across the US-affiliated Pacific Islands between 2007 and 2019. Patient data were obtained for individuals with primary head and neck cancers from the Pacific Regional Central Cancer Registry database. All cohorts were age-adjusted to the 2000 US Standard Population. Further analysis was performed on oral cavity cancers due to their clear predominance within the sample. A total of 585 patients with primary head and neck cancers were included. The average age was 54.5 ± 12.9 years, and most patients were male (76.8%). Oral cancer subsite analysis revealed the proportional incidence of buccal mucosa was higher in 5 of 9 jurisdictions when compared with the United States (p < 0.001). Tongue and lip cancers were not found to have significantly higher incidence proportions. Patients in the Pacific Islander group were less likely to be detected at earlier stages for cancers of the cheek and other mouth (p < 0.001), tongue (p < 0.001), and lips (p < 0.001) compared with the United States. Many Pacific Island populations are burdened with higher incidences of oral cancer with later staging. Further investigation is recommended to evaluate oral cancer-related outcomes and mortality in this region. 3 Laryngoscope, 133:1899-1905, 2023.

Association of Neoadjuvant Pembrolizumab for Oral Cavity Squamous Cell Carcinoma With Adverse Events After Surgery in Treatment-Naive Patients

Pembrolizumab, a monoclonal antibody targeting programmed cell death 1, is currently approved by the US Food and Drug Administration for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). The potential neoadjuvant role of programmed cell death 1 inhibitors in primary surgical management of HNSCC and effects on surgical outcomes are poorly understood. To evaluate the incidence of postoperative adverse events in treatment-naive patients with advanced oral cavity cancer receiving neoadjuvant pembrolizumab when compared with matched controls, as part of a window-of-opportunity multi-institutional clinical trial assessing neoadjuvant pembrolizumab for locally advanced HNSCC. This retrospective cohort study at a single tertiary academic institution included treatment-naive patients with local regionally advanced oral cavity squamous cell carcinoma (OCSCC) who were undergoing surgical resection. Patients with local regionally advanced resectable OCSCC who received neoadjuvant pembrolizumab were retrospectively reviewed for postoperative adverse events. Controls were matched by age, race, smoking status, and overall cancer stage based on historical data at the same institution. Matched-cohort analysis was performed using a McNemar test to assess differences between the groups. Incidence of adverse events following surgical resection of advanced OCSCC within 30 days of surgery and on continued follow-up. A total of 64 patients (32 as part of the prospective clinical trial and 32 as controls; mean [SD] age, 59.6 [10.3] years; 28 [44%] women) were included in the analysis. Postoperative adverse events in the 32 patients receiving pembrolizumab included lymphedema (n = 20 [63%]), trismus (n = 7 [22%]), return to operating room (n = 7 [22%]), wound infection (n = 7 [22%]), fistula (n = 6 [19%]), wound dehiscence (n = 4 [13%]), flap failure (n = 3 [9%]), and hematoma (n = 2 [6%]). The matched control group demonstrated similar complication rates without considerable differences, except for trismus (n = 16 [50%]), which was greater by a difference of 28.1% (95% CI, 5.6%-50.6%) in the control group. This cohort study examined surgical complications among patients with local regionally advanced OCSCC treated with neoadjuvant pembrolizumab and found that serious adverse events were similar to those in patients who underwent standard-of-care treatment. This suggests that there is no increased perioperative morbidity in the use of preoperative treatment with immunotherapy. Further prospective studies are needed to validate these findings for oral cavity cancer and other subsites of the head and neck.

The Evolving Epidemiology of Oral Cavity and Oropharyngeal Cancers.

In 1988, Blot and colleagues reported results from a U.S. case-control study of oral cavity or pharyngeal (oropharyngeal and hypopharyngeal) cancers, with results showing independent associations of smoking and alcohol with increased risk, multiplicative interaction effects between smoking and alcohol, and that nearly three-quarters of these cancers are attributable to smoking and alcohol. The report by Blot and colleagues represents a landmark in oropharyngeal cancer epidemiology. This study, the largest at the time, introduced several novel concepts in oropharyngeal cancer epidemiology that remain relevant today-etiologic heterogeneity, statistical interaction effects, adjusted attributable fractions, and disparities by sex and race/ethnicity. Perhaps the most significant recognition in the field since 1988 is the etiologic association of human papillomavirus (HPV, primarily HPV16) with cancers arising in the oropharynx. Today, more than 80% of oropharyngeal cancers in the United States are caused by HPV while only approximately 3% of oral cavity cancers are caused by HPV. This etiologic heterogeneity across head and cancer subsites revealed by HPV is manifest at the genetic/genomic, epidemiologic, and clinical levels. Tobacco and alcohol remain the major etiologic factors for oral cavity cancers while HPV is the major cause of oropharyngeal cancers. Thus, tobacco and alcohol control and prophylactic HPV vaccination remain the most promising prevention tools for oral cavity and oropharyngeal cancers at this time. Importantly, the ever-emerging alternative tobacco products, such as smokeless tobacco/snus, hookah and water pipes, e-cigarettes, flavored cigars and cigarillos, and oral dissolvable products, represent a key public health concern and the carcinogenic effects of these products remains an active area of investigation. See related article by Blot and colleagues, Cancer Res 1988;48:3282-7.

Racial disparities in receipt of guideline-concordant care for early-onset colorectal cancer in the U.S.

6544 Background: Early-onset colorectal cancer patients who are Black are less likely to survive than white patients, even for early-stage disease, possibly due to differences in receipt of guideline-concordant care. This study evaluated racial disparities in receipt of timely and guideline-concordant colon and rectal cancer care in a large nationwide sample. Methods: Non-Hispanic Black and white individuals aged 20-49 years newly diagnosed with colorectal cancer during 2004-2019 were selected from the National Cancer Database. Patients who received all care recommended by the National Comprehensive Cancer Network (staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy) for which they were eligible according to cancer subsite and clinical and pathological TNM stage were considered guideline concordant. Demographic characteristics (age and sex), comorbidities, and health insurance coverage type were added sequentially to a series of multivariable models to estimate contribution to racial disparities in receipt of guideline-concordant care. Racial disparities in time from diagnosis date (among rectal cancer patients eligible for neoadjuvant chemotherapy) and surgery date (among colon cancer patients eligible for adjuvant chemotherapy) to date of chemotherapy initiation was evaluated using restricted mean survival time. Results: Of the 84,728 colon and 62,483 rectal cancer patients, 20.8% and 14.5% were Black, respectively. Black patients were less likely to receive guideline concordant care than white patients diagnosed with colon and rectal cancer, respectively (Table). Demographic characteristics and comorbidities combined explained less than 5% of the disparity, while health insurance coverage type explained 28.6% and 19.4% of the disparity among colon and rectal cancer patients, respectively. Restricted mean time to chemotherapy was statistically significantly longer among Black than white patients for colon (54.0 vs 48.7 days, p &lt;.001) and rectal cancers (49.6 vs 40.9 days, p &lt;.001), respectively. Conclusions: Black patients diagnosed with early-onset colorectal cancer receive worse and less timely care than their white counterparts. Differences in health insurance coverage type, a modifiable factor, were the largest identified contributor to the racial disparities in receipt of guideline-concordant care, suggesting that improved access to care could help mitigate disparities in cancer outcomes. [Table: see text]

Peer review quality assurance in stereotactic body radiotherapy planning: the impact of case volume

Abstract Purpose: Peer review is an essential quality assurance component of radiation therapy planning. A growing body of literature has demonstrated substantial rates of suggested plan changes resulting from peer review. There remains a paucity of data on the impact of peer review rounds for stereotactic body radiation therapy (SBRT). We therefore aim to evaluate the outcomes of peer review in this specific patient cohort. Methods and materials: We conducted a retrospective review of all SBRT cases that underwent peer review from July 2015 to June 2018 at a single institution. Weekly peer review rounds are grouped according to cancer subsite and attended by radiation oncologists, medical physicists and medical radiation technologists. We prospectively compiled ‘learning moments’, defined as cases with suggested changes or where an educational discussion occurred beyond routine management, and critical errors, defined as errors which could alter clinical outcomes, recorded prospectively during peer review. Plan changes implemented after peer review were documented. Results: Nine hundred thirty-four SBRT cases were included. The most common treatment sites were lung (518, 55%), liver (196, 21%) and spine (119, 13%). Learning moments were identified in 161 cases (17%) and translated into plan changes in 28 cases (3%). Two critical errors (0.2%) were identified: an inadequate planning target volume margin and an incorrect image set used for contouring. There was a statistically significantly higher rate of learning moments for lower-volume SBRT sites (defined as ≤30 cases/year) versus higher-volume SBRT sites (29% vs 16%, respectively; p = 0.001). Conclusions: Peer review for SBRT cases revealed a low rate of critical errors, but did result in implemented plan changes in 3% of cases, and either educational discussion or suggestions of plan changes in 17% of cases. All SBRT sites appear to benefit from peer review, though lower-volume sites may require particular attention.

Effects of the Prior Use of Statins on Head and Neck Cancer Risk: A Hospital-Based Case-Control Study.

Mechanisms related to the potential beneficial effects of statins on cancer are mainly related to the inhibition of the mevalonate pathway. The purpose of this study was to assess the association between prior use of statins and the risk of head and neck cancer. A hospital-based case–control study was conducted at the Dentistry Hospital of the University of Barcelona, including 101 incident cases of head and neck cancer and 101 controls matched to cases by age and sex. Multivariate logistic regression models were used to assess the association between prior statin exposure and head and neck cancer risk. Of the 202 patients included in total, 28.2% had previously received prescriptions for statins. Prior use of statins was found in 25.7% of cases and 30.7% of controls. Exposure to statins was not associated with head and neck cancer risk (OR = 0.72; 95% CI 0.28–1.84; p = 0.49). There was also no time- or dose-dependent association. Similar trends were observed when analyzed by subsites of cancer and recurrence rate. Our findings do not support a beneficial effect of prior statin exposure on head and neck cancer risk. Future research relying on observational data should emulate randomized clinical trials before clinical implications for repurposing drugs can be drawn.

Enhancing Outpatient Symptom Management in Patients With Head and Neck Cancer

Patients with head and neck cancer manage a variety of symptoms at home on an outpatient basis. Clinician review alone often leaves patient symptoms undetected and untreated. Standardized symptom assessment using patient-reported outcomes (PROs) has been shown in randomized clinical trials to improve symptom detection and overall survival, although translation into real-world settings remains a challenge. To better understand how patients with head and neck cancer cope with cancer-related symptoms and to examine their perspectives on standardized symptom assessment. This was a qualitative analysis using semistructured interviews of patients with head and neck cancer and their caregivers from November 2, 2020, to April 16, 2021, at a regional tertiary center in Canada. Purposive sampling was used to recruit a varied group of participants (cancer subsite, treatment received, sociodemographic factors). Drawing on the Supportive Care Framework, a thematic approach was used to analyze the data. Data analysis was performed from November 2, 2020, to August 2, 2021. Patient perception of ambulatory symptom management and standardized symptom assessment. Among 20 participants (median [range] age, 59.5 [33-74] years; 9 [45%] female; 13 [65%] White individuals), 4 themes were identified: (1) timely physical symptom management, (2) information as a tool for symptom management, (3) barriers to psychosocial support, and (4) external factors magnifying symptom burden. Participants' perceptions of standardized symptom assessment varied. Some individuals described the symptom monitoring process as facilitating self-reflection and symptom detection. Others felt disempowered by the process, particularly when symptom scores were inconsistently reviewed or acted on. This qualitative analysis provides a novel description of head and neck cancer symptom management from the patient perspective. The 4 identified themes and accompanying recommendations serve as guides for enhanced symptom monitoring.

Prevalence of human papillomavirus types in head and neck cancer sub-sites in the Indian population.

Although a subset of head and neck cancers (HNC) has been associated worldwide with mucosal high-risk human papillomaviruses (HPV), information on the prevalence of HPV-positive HNC in India is limited. In this study, we examined the prevalence of 21 subtypes of HPV in sub-sites of HNC (n = 175) in the western region of India. Type-specific multiplex genotyping assay was conducted at the Centre for Cancer Epidemiology, Tata Memorial Centre, to determine the prevalence of HPV subtypes. The HPV prevalence was observed to be 28.43%, 41.67%, 38.89% and 15.79% in the oral cavity, oropharynx, hypopharynx and larynx tumour tissues, respectively. The HPV 16 genotype was most common in all HNC tumour tissues (30.29%), followed by HPV 58 (0.57%).

Cigarette Smoking Associated with Colorectal Cancer Survival: A Nationwide, Population-Based Cohort Study.

We investigate whether cigarette smoking is associated with survival in patients with colorectal cancer (CRC) through a nationwide population-based cohort study in Taiwan. The Taiwan Cancer Registry and National Health Insurance Research Database were used to identify data from patients with CRC from 2011 to 2017. Tobacco use was evaluated based on the smoking status, intensity, and duration before cancer diagnosis. A total of 18,816 patients was included. A Kaplan–Meier survival analysis indicated smoking to be significantly associated with the CRC mortality risk (log-rank p = 0.0001). A multivariable Cox model indicated that smoking patients had a 1.11-fold higher mortality risk (HR = 1.11, 95% CI = 1.05–1.19) than nonsmoking patients did. This increased risk was also present in patients with CRC who smoked 11–20 cigarettes per day (HR = 1.16; 95% CI = 1.07–1.26) or smoked for >30 years (HR = 1.14; 95% CI = 1.04–1.25). Stratified analyses of sex and cancer subsites indicated that the effects of smoking were higher in male patients and in those with colon cancer. Our results indicate that cigarette smoking is significantly associated with poor survival in patients with CRC. An integrated smoking cessation campaign is warranted to prevent CRC mortality.